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Gastroentrology > 2: Acute Mesenteric Ischaemia, Chronic Mesenteric Ischaemia, Abdominal Trauma > Flashcards

2: Acute Mesenteric Ischaemia, Chronic Mesenteric Ischaemia, Abdominal Trauma Flashcards

1
Q

What is acute mesenteric ischaemia

A

Sudden decrease in blood supply to the bowl that can cause infarction

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2
Q

What are the 4 types of acute mesenteric ischaemia

A
  1. Acute mesenteric arterial thrombosis
  2. Acute mesenteric arterial embolism
  3. Venous congestion
  4. Non-occlusive ischaemia
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3
Q

If ischaemia due to thrombosis in situ what is it called

A

Acute mesenteric arterial thrombosis (AMAT)

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4
Q

if ischaemia is due to embolism in situ what is it called

A

Acute mesenteric arterial embolism (AMAE)

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5
Q

What is a cause of acute mesenteric arterial thrombosis

A

Atherosclerosis

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6
Q

What are 5 causes acute mesenteric arterial embolism

A
  1. AF
  2. AAA
  3. Thoracic AA
  4. Mural thrombus
  5. Prosthetic heart valve
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7
Q

What are 2 causes of non-occlusive mesenteric ischaemia

A
  1. Cardiogenic shock

2. Hypovolaemic shock

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8
Q

What are 3 causes of venous occlusion

A
  1. Coagulopathy
  2. Thrombophilia
  3. Malignancy
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9
Q

What are risk factors for AMAT and AMAE

A 
Cardiovascular RF:
Smoking 
Alcohol 
HTN
Hypelripidaemia
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10
Q

How does acute mesenteric ischaemia present

A
  • Pain out of proportion to clinical findings
  • Diffuse, generalised abdominal pain
  • N+V
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11
Q

What investigations are ordered for acute mesenteric ischaemia

A
  1. ABG
  2. CT scan with contrast
  3. CXR
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12
Q

What will be seen on ABG

A
  • High lactate

- Metabolic acidosis

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13
Q

What imaging is used to definitely diagnose acute mesenteric ischaemia

A

CT with IV contrast

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14
Q

When is a CXR performed

A

If perforation is suspected

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15
Q

How is mesenteric ischaemia managed

A

IV Fluids

Broad-spec antibiotics

Surgery for re-vascularisation (with re-look 24-48h after)

Revascularisation

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16
Q

What are 3 complications of mesenteric ischaemia

A

Bowel necrosis
Bowel perforation
Short-gut syndrome post-resection

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17
Q

What is chronic mesenteric ischaemia

A

reduced blood supply to the bowel due to atherosclerosis

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18
Q

In which individuals does chronic mesenteric ischaemia occur

A

Elderly patients

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19
Q

What are 4 risk factors for chronic mesenteric ischaemia

A

Smoking
Hyperlipidaemia
HTN
DM

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20
Q

How does chronic mesenteric ischaemia present

A

Post-prandial pain (10m-4h)

Weight loss

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21
Q

Explain pathophysiology of chronic mesenteric ischaemia

A
  • Due to atherosclerosis of two blood vessels (SMA, IMA, Coeliac trunk). Due to collateral blood supply it must be 2.
  • Bowel receives sufficient oxygen at rest, however, struggles during increased demand: such as post-digestion.
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22
Q

What is first-line investigation for chronic mesenteric ischaemia

A

CT angiography

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23
Q

What is gold-standard for acute mesenteric ischaemia

A

CT with contrast

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24
Q

What is used to manage chronic mesenteric ischaemia

A

Modify risk factors

Endovascular repair = mesenteric angioplasty

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25
Q

Which sites are vulnerable to ischaemia and why

A

Watershed areas:
Splenic flexure and rectosigmoid junction

  • due to switch in blood supply
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26
Q

Define acute mesenteric ischaemia

A

ischaemia of the small intestine

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27
Q

Define ischaemic colitis

A

ischaemia of the large intestine

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28
Q

What causes ischaemic colitis

A

caused by global hypo perfusion caused by:

  • Hypotension
  • Hypovolaemia
  • Thrombophillia
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29
Q

how does ischaemic colitis present

A

Presents in 3 phases

  1. Hyperactive
  2. Paralytic
  3. Shock
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30
Q

how does the hyperactive phase of ischaemic colitis present

A

Colicky abdominal pain in the LIF.

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31
Q

how does the paralytic phase of ischaemic colitis present

A
  • Diffuse abdominal pain
  • Bloating
  • Absent bowel sounds
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32
Q

how does the shock phase of ischaemic colitis present

A
  • Acute abdomen
  • Guarding
  • Rebound tenderness
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33
Q

how is acute mesenteric ischaemia investigated

A

CT W/constrast

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34
Q

how is ischaemic colitis investigated

A

CT angiography

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35
Q

how is ischaemic colitis managed

A

IV Fluids
Antiplatelets

  • If necrotic may require resection
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36
Q

What are the two types of abdominal trauma

A
  • Blunt trauma

- Penetrating

37
Q

What is blunt trauma

A

Blunt force to the body - does not penetrate skin.

38
Q

What is penetrating trauma

A

Penetrates the skin.

39
Q

What are 3 causes of blunt trauma

A
  • RTA
  • Falls
  • Deceleration injuries or external crushing
40
Q

What are 2 causes of penetrating trauma

A
  • Gunshot wounds

- Stabbing

41
Q

What is the most common injury following blunt trauma

A

Splenic rupture (40%)

42
Q

What are 5 other injuries that can occur due to abdominal trauma

A
  • Liver haematoma
  • Pancreatic contusion
  • Intra-abdominal bleeding due to fracture ribs causing injury
  • Traumatic injury to bladder and kidney
  • Duodenal injury and haematoma
  • Pelvic fracture
43
Q

Why may blunt trauma cause intra-abdominal bleeds

A

Due to causing fracture of ribs - which are able to penetrate intra-abdominal organs

44
Q

What type of injury pancreatic contusion

A

Handlebar - trauma to epigastric region

45
Q

How will pancreatic contusion present clinically

A

Epigastric pain
N+V
Anorexia
Fever

46
Q

What is a common injury in children who suffer blunt abdominal trauma

A

Duodenal haematoma

47
Q

How will splenic rupture present

A

Hypotension - dizziness, syncope

Left hypogastric pain
Left shoulder irritation

48
Q

How will liver haematoma present clinically

A

Ecchymosis of the right chest - pain referred to right shoulder

49
Q

What is the most common site for gunshot wound to injure

A

Small bowel

50
Q

What is the most common site for stab wound to injure

A

Liver

51
Q

Explain signs of intra-abdominal bleeding

A
  • Hypotension
  • Tachycardia
  • Discolouration flanks
  • Shock
  • Rigid abdomen
  • Abdominal distention
52
Q

For blunt trauma, what is used pre-hospital to manage patients

A

ATLS

: any resuscitation required is undertaken

53
Q

What imaging is used for blunt trauma

A

FAST scan

Focused assessment with sonography for trauma

54
Q

What is FAST scan used to detect

A

Haemoperitoneum (intra-abdominal bleeding)

55
Q

If FAST scan is unavailable, what should happen to blunt abdominal trauma patients

A

Taken immediately to theatres

56
Q

If patient is stable and FAST scan is inconclusive what imaging is used

A

CT scan

57
Q

If patient is unstable and FAST scan inconclusive, what imaging is used

A

Diagnostic peritoneal lavage

58
Q

Explain diagnostic peritoneal lavage

A

Surgical investigation:

  • Incision made into abdomen
  • Catheter inserted and fluid aspirate
  • If blood aspirated, Hartmann’s solution is inserted and left for 5 minutes - then removed and sent for analysis
59
Q

What is second-line to FAST scan for investigaitng abdominal trauma

A

Laparotomy

60
Q

What are 3 indications of laparotomy

A
  • Haemodynamic instability
  • Clinical peritonitis
  • Intra-abdominal bleed detected on imaging
61
Q

What does management of abdominal trauma depend on

A

Site of injury

62
Q

How is pancreatic injury managed

A

Percutaneous drainage

63
Q

How is duodenal injury managed

A

NG tube and parental nutrition

64
Q

How are individuals with penetrating trauma managed in pre-hospital enviorment

A

ATLS

65
Q

What is important for penetrating trauma

A
  • Tetanus prophylaxis

- Antibiotics

66
Q

How is penetrating trauma managed

A
  • Tetanus prophylaxis
  • Antibiotics
  • Emergency exploratory laparotomy
67
Q

What are 6 indications for emergency exploratory laparotomy

A
  1. Extraviscation (organ outside)
  2. Peritonitis
  3. Haemodynamic instability
  4. Penetrating object in-situ
  5. PR bleed
  6. Free air under diraphragm
68
Q

How is ATLS approach to trauma divided

A
  • Primary survey

- Secondary survey

69
Q

What is the primary survey approach

A

Used to look for injuries that will require immediate resuscitation

70
Q

What is secondary survey

A

Used to scan for all other injuries

71
Q

what may be looked for on secondary surgery in abdominal trauma

A
  • Grey-turner’s sign
  • Cullen’s sign
  • Seatbelt sign
72
Q

What is the seat belt sign

A

Presence of bruising in mark resembling lap portion of seatbelt

73
Q

What is looked for on palpation in the secondary survey

A

Crepitus over lower ribs indicating splenic or liver damage

74
Q

When is FAST imaging indicated for abdominal trauma

A

Immediate imaging as part of secondary survey for haemodynamically unstable patients

75
Q

What is the problem with FAST scans

A

Poor at identifying retroperitoneal haemorrhage

76
Q

When is diagnostic peritoneal lavage used for diagnosis

A

Haemodynamically unstable patients

77
Q

What is the problem with diagnostic peritoneal lavage

A

May miss retroperitoneal haemorrhage and diaphragm injury

78
Q

When is abdominal CT ordered

A

Stable patient

79
Q

What is the advantage of abdominal CT

A

Good method for localising injury

80
Q

What is fluid resuscitation

A

Individual is given 500mL crystalloid fluid challenge. Then given up to 2L fluid

81
Q

How can individuals response to fluid be categorised

A
  1. Responder
  2. Transient responder
  3. Non-responder
82
Q

What is a responder

A

Demonstrates physiological improvement on fluid

83
Q

How much blood loss has a responder to fluid had

A

<20%

84
Q

What is a transient responder

A

Someone who initially demonstrates an improvement on fluid and then deteriorates

85
Q

How much blood loss has a transient responder had

A

20-40%

86
Q

What will a transient responder require

A

Blood products

87
Q

What is a non-responder

A

Someone who continues to deteriorate on fluid

88
Q

How much blood loss has a non-responder had

A

> 40%

Gastroentrology (18 decks)

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